There are situations in which a patient’s status (new or established) may be unclear. Keys to understanding the “3-year rule” is that the rule applies to the relationship established between the current physician or other qualified health care professional (QHP), or any other physician or QHP of the same group practice and exact same specialty, and the patient through a face-to-face encounter in any practice setting.

Can you determine whether the patient in each of the following scenarios is new or established to the treating physician? Circle your answer.

Dr A provided interpretation and report of an electrocardiogram for a patient in 2021. In 2022, Dr A receives a request to provide a telephone E/M service to the patient to whom Dr A has provided no other services. Does Current Procedural Terminology® prohibit reporting the telephone E/M code for Dr A’s service to this patient? Y N

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